Fifteen per cent of patients had a change in their treatment before falling. The average number of drugs per patient was nine per day. In these patients, the rate of prescription of drugs at risk of falling was high (87% for hypotensive treatments and 91% for inducing drowsiness treatments). A very high consumption of diuretics (40%) and benzodiazepines (60%) was observed. The combination of benzodiazepines was found in 16% of patients. Respectively, 24% and 65% of patients had a modification in their hypotensive and inducing drowsiness treatments. Conclusion The use of drugs that increased the risk of falling was common in our hospital. The recent change in inducing drowsiness treatments seemed to increase the risk of falling.Pharmaceutical interventions with prescribers on good prescribing practices in the elderly should be strengthened to minimise the use of drugs at risk of falling.
BackgroundRilpivirine is a recently authorised antiretroviral. Adherence is essential in this kind of drug.PurposeTo evaluate treatment adherence with rilpivirine/emtricitabine/tenofovir (RPV/FTC/TDF) using the SMAQ questionnaire and pharmacy dispensing records (FDR) and the correlation between these in HIV/AIDS mono-infected patients.Material and methodsProspective observational study. We included patients treated with RPV/FTC/TDF from September 2013 until September 2014 with adherence data available of at least 3 months. Demographics data and reason for treatment were collected.Adherence was calculated across the SMAQ questionnaire (qualitative and semi-quantitative) and FRD, considering the patient adherent when any of these parameters was ≥95%. The correlation between the methods was assessed using the kappa (k) index.Results33 patients started treatment with RPV/FTC/TDF during the above-mentioned period. 21 were included in the study. 71% were men (average age: 40 ± 10 years). 38% were treatment-naïve and the rest were changes of therapeutic strategy (33% adverse reactions and 29% simplification of treatment strategies).26% of patients were considered adherent from a qualitative point of view in the SMAQ questionnaire, 76% from a semi-quantitative perspective and 95% via the FRD. The results between the three analysis only coincided in 6 patients.As for the results of k index, we observed the following strength of agreement: fair between the SMAQ quantitative and qualitative questionnaires (k = 0.22) and slight between the SMAQ qualitative questionnaire and FRD (k = 0.04) and between semi-quantitative SMAQ and FRD questionnaire (k = 0.01).ConclusionOur study highlights a low adherence to treatment obtained with the SMAQ questionnaire (both qualitative and semi-quantitative). It may be due to both the inflexibility of the questions and because of the patient assessment. These results could be improved through a pharmacist intervention in the monthly clinical review.Correlation between the three methods was low, so their use in isolation may give erroneous results in predicting adherence. However, with this way, “hidden” non-adherent patients (adherent FRD and non-adherent SMAQ) and “masked” non-adherent patients (non-adherent FRD and adherent SMAQ) could be detected.References and/or acknowledgementsNo conflict of interest.
BackgroundThe primary goal of hepatitis C virus (HCV) therapy is to cure the infection. A sustained virological response (SVR) is defined as undetectable HCV RNA 12 weeks (SVR12) after treatment completion.PurposeTo assess the effectiveness of new direct acting antiviral agents, measuring HCV RNA, 12 weeks after treatment completion.Material and methodsPropective, descriptive, observational study conducted in a referral hospital for a population of 195 000 people, between September 2014 and September 2015. Patients with chronic HCV who had completed treatment with the new direct acting antivirals (DAAs) were selected. Viral load was measured during treatment and 12 weeks after treatment completion. Naïve and previously treated patients, as monoinfected and coinfected with HIV, were included. Demographic and clinical data were obtained from electronic medical records. The pharmacist followed-up patients, assessing treatment efficacy by the value for viral load.Results86 patients completed treatment during the study period, but only SVR12 data were obtained in 35 patients, which were included in the study. 65.7% were male and mean age was 55.8 ± 8 years. 74.3% of patients were from the gastroenterology department and 25,7% from the infectious diseases department, and 11.4% were coinfected with HIV. 85.7% of patients had liver fibrosis F4, measured with Fibroscan. Regarding previous treatment, 68.6% of patients were treated with interferon (IFN) and ribavirin, and 11.4% were treated with triple therapy regimens, being 31.4% non-responders, 28.6% relapsers, 11.4% intolerant to interferon and 8.6% partial responders. 20% were naïve. Genotype 1b was the most prevalent genotype (37.1%), followed by genotype 1a (22.9%). Treatment with DAAs was distributed as follows: 51.4% sofosbuvir with simeprevir; 31.4% sofosbuvir; 5.7% sofosbuvir with daclatasvir; 5.7% simeprevir; and 5.7% dasabuvir, ombitasvir, paritaprevir and ritonavir. 65.7% were IFN free combinations. 85.7% were treated for 12 weeks, while 14.3% were treated for 24 weeks. 68.6% of patients had a high baseline HCV RNA level (>800 000 IU/mL). At treatment completion, 100% of patients had undetectable viral load. 91.4% of them achieved SVR12.ConclusionDAAs showed high SVR12 rates (91.4%), and therefore constitute an effective treatment for HCV.References and/or AcknowledgementsPharmacy department.No conflict of interest.
Aim and objectives To assess the effectiveness and safety of ixekizumab in MTSPP in clinical practice. Material and methods A descriptive, retrospective, multicentre study was conducted. Patients with MTSPP receiving ixekizumab between 1 January 2017 and 30 September 2020 were included. Electronic clinical history and the prescription programme Farmatools were used to record data: sex, age, previous treatment, dosage and duration of therapy. Effectiveness was measured by the psoriasis area severity index (PASI): PASI-75 (!75% reduction in baseline PASI), PASI-90 (!90% reduction) and PASI-100 (total clearance of lesions) at weeks 12 and 36. Failure to achieve PASI-75 was considered no response. Safety was evaluated according to adverse events (AE) and discontinuations of treatment. Results 46 patients were included, 27 (59%) were men. Mean age was 49 (23-74) years. Previous treatments: methotrexate (n=33), cyclosporine (n=29) and biological therapy (n=35). Mean number of prior biological drugs was 3 (1-5), including anti-TNF (etanercept, n=23; adalimumab, n=22; infliximab, n=3), anti-IL-12-23 (ustekinumab, n=16) and anti-IL-17A (secukinumab, n=7). All patients received ixekizumab with an induction dose of 160 mg at week 0 and then 80 mg at weeks 2, 4, 6, 8, 10 and 12. Maintenance dose was 80 mg every 4 weeks in 34 (74%) patients and every 6 weeks in 12 (26%). Mean duration of ixekizumab therapy was 17 (3-44) months. Baseline PASI was >5 in all patients and >10 in 37 (80%) cases. Effectiveness was not evaluated in 5 (11%) patients at week 12 and in 8 (17%) patients at week 36 due to lack of information. At week 12: 1 (2%) patient presented PASI-75, 12 (26%) PASI-90, 23 (50%) PASI-100 and 5 (11%) no response. At week 36: 1 (2%) patient achieved PASI-75, 15 (33%) PASI-90, 16 (35%) PASI-100 and 6 (13%) no response. Regarding the safety profile, 3 (7%) patients presented AE: alopecia, eosinophilia and injection site reaction. No discontinuations of treatment were reported. Conclusion and relevance Ixekizumab was effective and provided total clearance of MTSPP lesions to half of the patients by week 12, with this considerable response in more than a third of patients at week 36. Ixekizumab was well tolerated, with a low frequency of AE.
Background and importance Pain is highly prevalent in old, frail adults with paracetamol as the mainstay treatment. Pain management is regularly suboptimal and using different paracetamol formulations might improve pain control.
BackgroundOff-label prescription is legal and common, but often not supported by strong evidence.PurposeTo analyse off-label treatments with biological therapies, its indications and to determine its economic impact within the total cost of these drugs.Material and methodsThis observational descriptive study was conducted in a reference hospital from October 2015 to March 2016. Treatments codified in the dispensation system (Savac) according to the diagnosis ‘Treatments not included in data sheet’ and those who had a defined diagnosis but were not reflected in the data sheet were included.Drug, diagnosis and clinical service prescriber were collected from the electronic clinical record (Selene) and request reports sent to the pharmacy. The number of dispensations and spending (both off-label and total spending on biological therapy in the study period) was recorded from Savac.ResultsDuring the study period 34 off-label treatments were prescribed to 32 patients. Applicant services were: internal medicine (35.3%), allergology (26.5%), digestive (12.7%), dermatology (11.8%), ophthalmology (8.8%) and rheumatology (2.9%). 11 drugs were used in 18 different indications. The most employed was omalizumab with 26.5% (33.33% food allergy, 33.33% anaphylaxis and the rest for atopic dermatitis, allergic rhinitis and urticaria acute recurrent) followed by adalimumab with 14.7% (uveitis non-infectious), ustekinumab with 11.8% (75% Crohn’s disease and 25% atopic dermatitis), tocilizumab with 11.8% (spondyloarthritis, papilophlebitis, thyroid associated orbitopathy and uveitis), and the rest had low values. In terms of economic impact, off-label use represented 4.73% (€122 482.7) of total expenditure on biological therapies during the study period; 1.19% at the cost of omalizumab. Regarding the total cost of each drug, off-label use was 57.34% of total expenditure for tocilizumab; 11.55% for rituximab, 10.85% for omalizumab, 8.91% for ustekinumab and less than 5% for the rest.ConclusionOur study results showed that off-label use of biological agents has important economic and healthcare impact; some biologicals represented >50% of expenditure (eg, tocilizumab). A monitoring mechanism should be set up to evaluate the efficacy and safety of these treatments due to insufficient clinical experience with them.No conflict of interest
Background and importance Dalbavancin is a semisynthetic glycopeptide active against Gram-positive bacteria, approved in acute bacterial skin and skin structure infections(ABSSSI). Its use has been extended, in selected patients, to other complicated infections to avoid prolonging the hospital stay, such as: endocarditis, bacteraemia with difficulty controlling focus, and osteoarticular infections. The usual treatment regimen is a loading dose of 1500 mg followed by 1000 mg after 15 days. Aim and objectives The objective of the study was to evaluate the days of hospital stay avoided with the use of dalbavancin in these patients. Material and methods Observational, transversal, unicentre study in patients hospitalised between August 2020 and October 2021 in a third-level hospital who had received at least one dose of dalbavancin after discharge. The days of stay avoided were calculated according to the doses of dalbavancin administered. Information sources: electronic prescription programme ATHOS-Prisma and computerised medical record Diraya.Results Thirty patients were included, the mean age was 63 ±17 years, 17 (56.7%) were men and 13 (43.3%) women. 43.3% suffered from endocarditis, 26.7% osteoarticular infections; 13.3% bacteraemia with difficulty controlling focus; 10.0%, ABSSSI; and 6.7%, other types of infections. The most frequently isolated microorganisms were: Staphylococcus spp 54.8% of the cases and Enterococcus spp 22.6%. The median hospital stays according to pathology were: endocarditis, 20±13 days; ABSSSI, 7±3 days and bacteraemia with difficulty controlling focus, 21±5 days. In osteoarticular infections, differences were found between spondylodiscitis, whose median of hospital stay was 31±6 days, and septic prosthetic infections, 12±3 days. In ABSSSI, the media was reduced by half, and in osteoarticular infections an average of 30 days per patient was avoided. In patients with endocarditis, in 61.5% (8/13) of the cases, 30 days of hospital stay were avoided; in 23.1% (3/13), 15 days; and, in the rest of patients, 15.4% (2/13), the hospital days avoided were not estimated because the treatment with dalbavancin was prolonged due to patient comorbidities. Conclusion and relevanceThe use of dalbavancin in selected patients, in infections that require a prolonged hospital stay due to the patient receiving intravenous treatment, has been shown to be useful in shortening the length of hospital stay.
Conclusion Based on these results, we have identified some solutions to reduce the risk: the double-check carried out by two different people could solve the risk due to incorrect labelling; and the software used by pharmacists can be improved to reduce the risk related to the patients' allergy or cross-reaction. Finally, errors can be reduced through clearer and specific sessions of training for the compounders.
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